Notre Dame University

College of Health Sciences

Cotabato City

A CASE STUDY ON CELIAC DISEASE

B2 – Group 1:

Ibrahim, Raiyanah P.
Imam, Prince Yuseph Ramsey U.
Interino, Johaina G.
Ismael, Kasrah Mae M.
Jinang, Tadzmalyn H.
Kasan, Lyra Azneena M.

Clinical Instructor:

Prof. Greg L. Barata, RN

 INTRODUCTION

Celiac disease, also called gluten enteropathy or celiac sprue, is a malabsorption disorder

caused by an autoimmune response to consumption of products that contain the protein gluten.

Gluten is most commonly found in wheat, barley, rye, and other grains, malt, dextrin, and brewer’s

yeast. Celiac disease is hereditary, which has a familial risk component particularly among first-

degree relatives and has a 1 in 10 risk of developing it. It is more common in young children ages

6 to 24 months, but it may manifest at any age in a person who is genetically predisposed. Women

are also afflicted twice as often as men and this disease is more common among Caucasians,

although the rates of celiac disease are on the rise among non-Caucasians as well (NIDDK, 2016).

According to the Celiac Disease Foundation (n.d.), it is estimated that 1 in 100 people

worldwide has celiac disease, but only 10-15% of them are diagnosed. Historically, celiac disease

was first described in areas where gluten containing grains were staple food, like in Western

countries. Over time, an increasing incidence of celiac disease has been observed in Asian

countries due to global changes in the diet, mostly related to higher consumption of wheat-based

products. In Southeast Asian countries, including the Philippines, have only 5-10% prevalence in

the general population (Catassi et al., 2015). The prevalence of celiac disease in Cotabato City,

Philippines was not identified in this case study due to limited accessibility of local data for the

students.

Globally, celiac disease is becoming increasingly common, and its diagnosis and treatment

are gaining more attention. This case study aims to provide a detailed overview of celiac disease,

including its prevalence, pathophysiology, signs and symptoms, causes, risk factors, medical and

nursing diagnosis and management, prognosis, and recommendations.

 CASE ANALYSIS

The following is a scenario of a 19 year-old female, Liz Gavin, who came into the

Emergency Department by the ambulance in the morning with complaints of diarrhea and nausea

and vomiting for a week, abdominal pain, weight loss of 15 pounds in one month, fatigue,

dehydration, severe thirst, and had large volumes of watery stools with steatorrhea, without blood

or mucus (frequency of 5 times a day). She has a family history of Diabetes type 1, Celiac Disease,

Rheumatoid Arthritis, and Psoriasis. She has a personal history of Celiac Disease, chronic

constipation, weight loss, and abdominal pain associated with her Celiac Disease diagnosis. In the

Emergency Department, her labs were taken and she had a hemoglobin of 9, a hematocrit of 32, a

potassium of 2.8, a total protein of 5.0, a calcium of 8, a magnesium of 1.0, and metabolic acidosis.

A stool collection for fecal fat was also requested which showed an increase in her fecal fat. Her

vitals in the emergency department were heart rate of 103, respiratory rate of 20, blood pressure

of 85/50, oxygen saturation of 98%, temperature of 98.7 degrees Fahrenheit, and stabbing pain of

8 in her abdomen. Liz was diagnosed with Celiac Crisis. Celiac Crisis is a life-threatening form of

Celiac Disease that starts with the classic gastrointestinal symptom of diarrhea that leads to

dehydration and electrolyte imbalances (Hijaz, Bracken, & Chandratrem, 2014).

She was transferred to the ICU for care. In the ICU she was treated for her dehydration,

fluid and electrolyte imbalances, hypotension, nausea/vomiting, and her overall Celiac Crisis. This

was done with intravenous lactated ringers solution at 150 mL/hr, supplements of potassium at 40

mEq IV in 100 mL NS at 20 mL/hr, magnesium of 2 g IV in 100 mL NS at 10 mL/hr, and calcium

of 1 g IV in 100 mL NS at 5 mL/hr. She was also given norepinephrine to increase her blood

pressure, Zofran for her nausea, dapsone for her skin rash, and prednisone to treat the overall Celiac

Crisis. A low-calorie (500 kcal/day) diet without lactose and gluten was introduced. Upon
assessment the primary nurse found that the cause of Liz’s Celiac Crisis was due to nonadherence

to her dietary regimen. She is a freshman in college and though she was compliant to her gluten

free diet previously, the pressures of fitting into a new school and environment led her to stop her

diet. During the patient's teaching, she was educated by the nurse on the signs of Celiac Crisis in

the future in order to get help immediately. She was also referred to a dietician, case management,

and tele psych in order to help her cope with her disease process and prevent complications in the

future.

ANATOMY/PATHOPHYSIOLOGY

Celiac Disease is also known as gluten-sensitive enteropathy. It is an autoimmune

condition where it is triggered by gluten which is the single major environmental factor which

causes an immune reaction causing inflammation in the small bowel. Gluten is a protein storage

present in wheat, rye, and barley, as well as other grains. This causes the immune system to destroy

the intestinal villi. These are tiny hair-like projections that line the inside of the small intestine.

They contain blood vessels and help absorb nutrients. Celiac disease is also associated with certain
genetic variations that affect the immune system's ability to recognize gluten as a harmless

substance. The genes that are most strongly linked to celiac disease are HLA-DQ2 and HLA-DQ8,

which code for proteins that are involved in the presentation of gluten to immune cells HLA-DQ2

is found in up to 95% of patients with celiac disease. The remaining patients mainly have HLA-

DQ8. In celiac disease once a gluten is present there will be an epithelial innate immune response

caused by inappropriate T-lymphocyte in the epithelium and an adaptive immune response from

lamina propria which forms the connective tissue core of the villi and surrounds the crypt

epithelium which replenish dead epithelial cells in villi. This causes autoantibodies, or antibodies

against own tissue to form in response to exposure to gluten and autoantibodies target the epithelial

cells of the intestine causing inflammation in this area. There are two antibodies that are affected

by this disease, the first one is the Anti- tissue transglutaminase (anti- TTG) and the second is

Anti- endomysial antibodies (anti- EMA). These antibodies also relate to disease activities, so they

will rise and fall depending on how active the disease is. The inflammation caused by this affects

the small bowel particularly the jejunum which is after the duodenum and causes intraepithelial

lymphocytosis due to inflammation and atrophy of the intestinal villi causing a shorten and

flattened villi that will lead to inability to absorb nutrients, which cause malabsorption of vitamins,

minerals, and essential nutrients causing the symptoms of the disease.

SIGNS AND SYMPTOMS

● Diarrhea - due to the maldigestion and malabsorption of nutrients.

● Nausea and Vomiting - due to the inflammation and damage that occur in the lining of the

small intestine when a person with celiac disease consumes gluten.

● Abdominal pain - due to the inflammation and damage caused by the immune response to

gluten in the small intestine can cause discomfort and pain in the abdominal region.

● Weight loss - due to the body's ability to absorb nutrients is impaired.

● Fatigue - because the inflammation and damage caused by the immune response to gluten in

the small intestine can lead to malabsorption of nutrients, which can result in anemia, a

condition where the body lacks enough healthy red blood cells to carry oxygen to the body's

tissues and organs.

● Chronic constipation - this is because celiac disease damages the intestinal villi so that it is

unable to fully absorb nutrients and leads to hardened stool that’s difficult to pass, resulting

in constipation.

● Dehydration - it occur due to diarrhea or vomiting, which are more common symptoms of

the disease.

● Severe thirst - if a person with celiac disease is experiencing dehydration due to diarrhea or

vomiting, they may feel thirsty as a result.

● Watery stool with steatorrhea - because the inflammation and damage caused by the

immune response to gluten in the small intestine can interfere with the proper absorption of

fat.

● Skin Rash - the rash is caused by the deposition of IgA antibodies under the skin, which is

triggered by the ingestion of gluten.

● Hypotension - it can occur due to severe dehydration or malabsorption of nutrients.

● Fluid and electrolyte imbalance - due to the malabsorption of nutrients that can occur in the

small intestine when it is inflamed and damaged by the immune response to gluten.
 RISK FACTORS

Having a family history of the following conditions:

● Type 1 Diabetes - Approximately half of the risk of T1DM can be attributed to genetic factors,

with the most notable genes being HLA-DQ2 and DQ8, which are closely linked to an elevated

risk of Celiac Disease. Consequently, individuals with T1DM are at an increased likelihood of

developing Celiac Disease.

● Celiac Disease - This increased risk is thought to be due to a combination of genetic and

environmental factors.

● Rheumatoid Arthritis - Rheumatoid arthritis and celiac disease are autoimmune diseases with

increasing global prevalence that share common features such as HLA mutations, serological

markers, and joint and gastrointestinal symptoms, which has led to a connection being

established between them.

● Psoriasis - because both psoriasis and celiac disease are autoimmune disorders, in which the

immune system attacks healthy cells in the body.

CAUSES

● Genes - Celiac disease is strongly associated with two groups of normal gene variants, DQ2

and DQ8. The condition has a strong genetic component, and certain variations in the human

leukocyte antigen (HLA) genes, which play a role in the immune system, are associated with

an increased risk of developing celiac disease. People without these genes are unlikely to

develop the disease.

● Gluten - Celiac disease is caused by an abnormal immune system response that is triggered

when gluten is consumed.

 DOCTORS ORDER
Patient Name: Liz Gavin

Age: 19 years old

Gender: Female

Diagnosis: Celiac Crisis

Medications:

● Norepinephrine 8 mg in 250 mL D5W, titrate to maintain MAP > 65

● Zofran 4 mg IV every 8 hours PRN nausea/vomiting

● Dapsone 100 mg orally once daily

● Prednisone 40 mg orally once daily

Intravenous Therapy:

● Lactated Ringer's solution at 150 mL/hr

● Potassium 40 mEq IV in 100 mL NS at 20 mL/hr

● Magnesium 2 g IV in 100 mL NS at 10 mL/hr

● Calcium gluconate 1 g IV in 100 mL NS at 5 mL/hr

Diet:

● Low-calorie (500 kcal/day) diet without lactose and gluten

Consultations:

● Dietician

● Case management

● Tele psych
 LAB TESTS AND RESULTS

HEMOGLOBIN: 9 G/DL (LOW)

● Normal Range: 12.0-15.5 g/dL (female)

● Interpretation: Liz is suffering from anemia, likely due to malabsorption of nutrients

caused by the underlying Celiac Disease.

HEMATOCRIT: 32% (LOW)

● Normal Range: 34.9-44.5% (female)

● Interpretation: Liz is suffering from anemia, likely due to malabsorption of nutrients

caused by the underlying Celiac Disease.

POTASSIUM: 2.8 MMOL/L (LOW)

● Normal Range: 3.5-5.1 mmol/L (female)

● Interpretation: Liz is suffering from electrolyte imbalances.

TOTAL PROTEIN: 5.0 G/DL (NORMAL)

● Normal Range: 6.0-8.3 g/dL (female)

● Interpretation: Liz's total protein level is within the normal range.

CALCIUM: 8.0 MG/DL (NORMAL)

● Normal Range: 8.5-10.2 mg/dL (female)

● Interpretation: Liz's calcium level is within the normal range, suggesting adequate

calcium intake or early stages of calcium depletion due to malabsorption.

MAGNESIUM: 1.0 MG/DL (LOW)

● Normal Range: 1.6-2.4 mg/dL (female)

● Interpretation: Liz is suffering from electrolyte imbalances.

METABOLIC ACIDOSIS: PRESENT

● Interpretation: The metabolic acidosis is likely caused by the large volumes of watery

stools and steatorrhea.

FECAL FAT: INCREASED

● A positive test result is indicated if the patient has 6g of fat present in stool after 24

hours.

● Interpretation: The increased fecal fat confirms malabsorption of fat in the intestines.

DRUG STUDY (MEDICATIONS)

NOREPINEPHRINE

Generic Name: Norepinephrine

Brand Name: Levophed

Classifications: Sympathomimetic, Vasopressor

PHARMACOKINETICS:

● Absorption: IV administration results in immediate and complete bioavailability.

● Distribution: It rapidly distributes throughout the body and has a short half-life.

● Metabolism: It undergoes extensive metabolism in the liver and other tissues.

● Elimination: The majority of the drug is eliminated through urine and some through

feces.

● Onset: Immediate

● Peak: Within 1 to 2 minutes

● Duration: 1 to 2 minutes
PHARMACODYNAMICS:

● Norepinephrine is a potent alpha and beta-1 adrenergic agonist that increases systemic

vascular resistance, blood pressure, and cardiac output.

INDICATION:

● Norepinephrine is indicated for the treatment of hypotension and shock.

USUAL DOSE:

● The usual dose range for norepinephrine is 0.01 to 0.5 mcg/kg/min.

ACTUAL DOSE:

● 8 mg in 250 mL D5W, titrate to maintain MAP > 65.

CONTRAINDICATIONS:

● Norepinephrine is contraindicated in patients with hypotension caused by

hypovolemia.

SIDE EFFECTS:

● Common side effects include hypertension, bradycardia, headache, and peripheral

vasoconstriction.

ADVERSE EFFECTS:

● Adverse effects include arrhythmias, myocardial ischemia, and mesenteric and

peripheral ischemia.

NURSING RESPONSIBILITIES:

BEFORE:

● Verify correct medication, dose, and concentration with the provider's order.

● Check the patient's blood pressure, heart rate, and urine output before administering

norepinephrine.
 ● Assess for contraindications such as allergy, hypotension, and tachyarrhythmias.

DURING:

● Administer norepinephrine through a central venous line or a large bore peripheral IV

line.

● Continuously monitor the patient's blood pressure, heart rate, urine output, and

peripheral circulation.

● Titrate the dose of norepinephrine as ordered to maintain a MAP >65 mmHg.

● Monitor for adverse effects such as hypertension, tachycardia, dysrhythmias, and

extravasation.

AFTER:

● Discontinue the norepinephrine infusion as ordered.

● Assess the patient's blood pressure, heart rate, urine output, and peripheral circulation

after discontinuing the infusion.

● Monitor the patient for rebound hypotension or bradycardia.

● Document the administration, titration, and discontinuation of norepinephrine in the

patient's medical record.

ZOFRAN

Generic Name: Ondansetron

Brand Name: Zofran ODT

Drug Classification: Antiemetic agent (5-HT3 receptor antagonist)

PHARMACOKINETICS:

● Absorption: Zofran is well absorbed after oral administration with peak plasma

concentrations occurring within 1-2 hours. The bioavailability of oral ondansetron is

 approximately 60-65% due to first-pass metabolism. Oral disintegrating tablets have a

higher bioavailability of approximately 90%.

● Distribution: Ondansetron has a volume of distribution of approximately 140 L. It is

highly protein-bound (70-76%) to plasma proteins, mainly to alpha-1 acid glycoprotein

and albumin.

● Metabolism: Ondansetron is extensively metabolized in the liver by multiple enzymes,

including CYP3A4, CYP2D6, and CYP1A2.

● Elimination: Ondansetron is eliminated primarily by hepatic metabolism and subsequent

renal excretion. The elimination half-life is approximately 4-6 hours in adults and up to

9 hours in neonates. Approximately 70% of the drug is eliminated in the urine and 10-

20% in the feces.

Oral:

● Onset: 30-60 minutes after ingestion

● Peak: 1-2 hours after ingestion

● Duration: 4-8 hours

Oral Disintegrating Tablet (ODT)

● Onset: 15-30 minutes after ingestion

● Peak: 1-2 hours after ingestion

● Duration: 4-8 hours

PHARMACODYNAMICS

● Ondansetron works by blocking the action of serotonin, a neurotransmitter that can

trigger nausea and vomiting.

INDICATION
 ● Most commonly used for the empiric treatment of nausea and vomiting.

CONTRAINDICATION

● Zofran should not be used in patients with a known hypersensitivity to ondansetron or

any of its components.

USUAL DOSE:

Injectable solution: 2mg/mL

Tablet: 4mg, 8mg, 24mg

Oral solution: 4mg/5mL

Orally disintegrating tablet: 4mg, 8mg

ACTUAL DOSE:

● Zofran 4 mg IV every 8 hours PRN nausea/vomiting

SIDE EFFECTS:

● Common side effects include: Headache, Constipation, Diarrhea, Fatigue. Dizziness, and

Dry mouth

ADVERSE EFFECTS:

● Adverse effects include Allergic reactions such as rash, hives, swelling of the face or

tongue, or difficulty breathing, Irregular heartbeats, Low blood pressure, Seizures,

Blurred vision, and Changes in mood or mental state.

NURSING RESPONSIBILITIES

BEFORE:

● Check the patient's medical history, current medications, and potential allergies to the

medication.

● Assess the patient's nausea and vomiting status.

 ● Verify the correct medication, dose, and route of administration.

● Explain the purpose of the medication and potential side effects.

DURING:

● Administer the medication according to the prescribed route and dose.

● Observe the patient for any adverse reactions, such as allergic reactions, dizziness, or

headache.

● Record the administration details in the patient's chart or electronic health record.

● Provide the patient with water or other fluids as needed after oral administration.

AFTER:

● Monitor the patient for any potential side effects or adverse effects of Zofran, such as

headache, constipation, or allergic reactions.

● Assess the patient's response to the medication, including any changes in nausea and

vomiting status.

● Document the patient's response and any observed side effects or adverse effects in the

patient's chart or electronic health record.

● Educate the patient about the proper use of the medication and any precautions or

instructions for taking the medication.

● Provide the patient with information about when to contact their healthcare provider if

they experience any unusual symptoms or side effects.

DAPSONE

Generic Name: Dapsone

Brand Name: Avlosulfon

Classifications: Antibacterial, Leprostatic Agent

PHARMACOKINETICS:

● Absorption: Rapidly absorbed after oral administration.

● Distribution: Widely distributed in the body.

● Metabolism: Metabolized in the liver.

● Elimination: Excreted in the urine, primarily as metabolites.

● Onset: Not specified.

● Peak: 2-3 hours.

● Duration: 24-48 hours.

PHARMACODYNAMICS:

● Dapsone is a sulfone antibiotic that works by inhibiting the bacterial dihydropteroate

synthetase enzyme, which is involved in the synthesis of folic acid. This leads to a

decrease in bacterial growth and reproduction. In addition, Dapsone has anti-

inflammatory and immunosuppressive properties, which make it useful in the treatment

of skin conditions such as leprosy and dermatitis herpetiformis.

INDICATION:

● Treatment for dermatitis herpetiformis.

USUAL DOSE:

● 25-50 mg orally once daily

ACTUAL DOSE:

● 100 mg orally once daily.

CONTRAINDICATIONS:

● Hypersensitivity to dapsone or any component of the formulation.

 ● Severe anemia or hemoglobinopathy.

SIDE EFFECTS:

● Nausea, vomiting, headache, dizziness, insomnia, and skin rash.

ADVERSE EFFECTS:

● Hemolytic anemia, methemoglobinemia, agranulocytosis, hepatitis, and peripheral

neuropathy.

NURSING RESPONSIBILITIES

BEFORE:

● Obtain a complete medical history including any allergies to medications or sulfa

products.

● Assess the patient for glucose-6-phosphate dehydrogenase deficiency (G6PD) as this

medication can cause hemolysis in patients with this deficiency.

● Monitor liver function tests and complete blood count (CBC) before starting therapy

and periodically throughout treatment.

● Assess the patient's skin condition before administration of the medication.

DURING:

● Monitor the patient for skin rashes or signs of hemolytic anemia, such as pale skin or

dark urine.

● Monitor liver function tests and CBC regularly throughout treatment.

● Assess the patient's response to therapy and monitor for adverse reactions.

AFTER:

● Monitor the patient for any ongoing adverse reactions, and report to the healthcare

provider as appropriate.
 ● Schedule follow-up appointments to assess the patient's response to therapy and

monitor for any potential long-term adverse effects.

PREDNISONE

Generic Name: Prednisone

Brand Name: Aspen Prednisone

Classifications: Corticosteroid

PHARMACOKINETICS:

● Absorption: Rapidly absorbed from the gastrointestinal tract, and it usually takes effect

within 1 to 2 hours

● Distribution: Wide distribution.

● Metabolism: First metabolized in the liver to its active form, prednisolone, a

glucocorticoid agonist corticosteroid.

● Elimination: Excreted in kidney, mainly in urine.

● Half-life: 18-36 hours

● Onset: intravenously, within minutes to hours after administration. Orally, within a few

hours of being taken.

● Peak: within 2 to 4 hours of administration.

● Duration: approximately 12 to 36 hours, depending on the dose and the patient's

individual response.

PHARMACODYNAMICS:

● Corticosteroids bind to the glucocorticoid receptor, inhibiting pro-inflammatory

signals, and promoting anti-inflammatory signals.

INDICATION

● prednisone may be prescribed to manage symptoms or complications of celiac disease.

Celiac disease causes severe inflammation or damage to the small intestine, in which

prednisone may be prescribed to reduce inflammation or immune-mediated reactions

and promote healing.

CONTRAINDICATION

● Individuals who have a known hypersensitivity or allergy to prednisone or any of its

components should not take this medication.

Contraindicated with those with systemic fungal or viral infections, glaucoma, gastric

or duodenal ulcers, psychoses and should be administered with live or life-attenuated

vaccines.

USUAL DOSE

● Adults: can range from 5-60 mg per day, depending on the condition being treated.

● For children, the dose is typically based on weight and may range from 0.5-2

mg/kg/day.

ACTUAL DOSE

● Prednisone 40 mg orally once daily.

SIDE EFFECTS:

● Common side effects include: weight gain, ingestion, insomnia, restlessness, excessive

sweating, and mild mood changes.

ADVERSE EFFECTS:

● The primary adverse effects of prednisone include hyperglycemia, insomnia, increased

appetite, hypertension, osteoporosis, edema, adrenal suppressions, cataracts, and

 delayed wound healing.

Adverse effects are common in patients receiving glucocorticoids in high doses or over

a long period.

NURSING RESPONSIBILITIES

BEFORE:

● Review the patient's medical history, including any allergies, current medications, and

medical conditions.

● Verify the dosage and route of administration prescribed by the physician, as well as

the timing and frequency of the dose.

● Educate the patient on the purpose of prednisone, including its potential benefits and

side effects.

● Provide instructions on how to take the medication, such as whether it should be taken

with food, and when to take it.

DURING:

● Prednisone can be administered orally or intravenously. If administering orally, ensure

the patient takes the medication with food to minimize gastrointestinal upset. If

administering intravenously, monitor the patient for any signs of a reaction.

● Monitor the patient for any adverse reactions or side effects, such as changes in blood

pressure, blood sugar, and mood.

● Encourage the patient to report any symptoms or concerns that arise while taking the

medication.

● Ensure that the patient's vital signs, laboratory values, and fluid balance are monitored

regularly to assess the effectiveness and safety of the medication.

 AFTER:

● Prednisone can cause long-term side effects such as osteoporosis, muscle weakness,

and weight gain. Monitor the patient for ongoing adverse effects and report any

changes to the healthcare provider.

● If a patient has been taking prednisone for an extended period of time, they may

experience withdrawal symptoms when the medication is discontinued. Symptoms can

include fatigue, weakness, and joint pain. Monitor the patient for withdrawal symptoms

and provide appropriate support and management.

● Some patients may experience a relapse of their condition after stopping the

medication. It is important to monitor the patient for any signs of relapse and report

them to the healthcare provider if necessary.

● Provide information about lifestyle changes or interventions that can help mitigate

potential complications.

MEDICAL DIAGNOSIS

Here are the steps typically involved in diagnosing celiac disease:

1- Medical and family history

● The doctor would ask for patient's medical history if they had other bowel diseases earlier in

their life. The doctor may also ask information on family history of celiac disease.

2- Physical examination

The patient may be examined for the following conditions:

● The doctor will examine patient's whole body whether rashes, blisters, and itchy feel are

present. These are very common conditions of malnutrition.

 ● Using the stethoscope, he may listen to the sounds of the bowel movements.

● The doctor may press the abdomen to check for fullness, pain, and swelling.

● The doctor can check for dental enamel defects such as white, yellow, or brown spots on the

teeth because people with celiac disease have these problems as first notable symptoms.

3- Blood test

Doctors may order two blood tests to help diagnose celiac disease:

1.) Serology testing looks for antibodies in the blood. Elevated levels of certain antibody proteins

indicate an immune reaction to gluten. Is done to test the presence of Autoantibodies seen in

celiac disease, specifically transglutaminase and endomysial antibodies.

2.) Genetic testing for human leukocyte antigens (HLA-DQ2 and HLA-DQS) can be used to rule

out celiac disease.

4- Endoscopy Biopsy

● If blood tests suggest celiac disease, your doctor may recommend an endoscopy. It is

considered as the gold standard for the diagnosis of Celiac Disease. During this procedure,

a small camera is inserted through the esophagus down to the small intestine to look for

signs of damage to the lining.

● If signs of damage are found during the endoscopy, a biopsy (tissue sample) of the small

intestine may be taken to confirm the diagnosis.

NURSING DIAGNOSIS

1. Fluid Volume Deficit related to Diarrhea and Vomiting Secondary to Celiac Disease.

2. Imbalanced Nutrition: less than body requirements related to Reduced Absorption of Nutrients
 Secondary to Celiac Disease, as evidenced by diarrhea, nausea and vomiting, abdominal pain,

and weight loss.

NURSING INTERVENTIONS

Fluid Volume Deficit related to Diarrhea and Vomiting Secondary to Celiac Disease.

1. Assess vital signs

Rationale: Vital signs may be abnormal if dehydrated which may show hypotension,

tachycardia or tachypnea

2. Urge the patient to drink the prescribed amount of fluid.

Rationale: to compensate for the fluid loss.

3. Assess fluid intake and output.

Rationale: to ensure that the patient has adequate fluid balance.

4. Administer intravenous hydration if needed.

Rationale: Severely dehydrated patients or patients unable to take oral hydration may require

IV hydration to maintain appropriate hydration level.

5. Provide measures to prevent excessive electrolyte loss

Rationale: Fluid losses from diarrhea must be treated with antidiarrheal medications, as

prescribed.

6. Educate patient about possible causes and effects of fluid loss or decreased fluid intake.

Rationale: Enough knowledge aids the patient in taking part in their plan of care.

7. Identify an emergency plan, including when to ask for help.

Rationale: Some complications of deficient fluid volume cannot be reversed in the home and

are life-threatening. Patients progressing toward hypovolemic shock will need emergency care.
Imbalanced Nutrition: less than body requirements related to Reduced Absorption of

Nutrients Secondary to Celiac Disease, as evidenced by diarrhea, nausea and vomiting,

abdominal pain, and weight loss.

1. Assess the patient's nutritional status.

Rationale: to distinguish if there is a nutrition issue, identify the problem, and determine the

severity.

2. Explore the patient’s daily nutritional intake and food habits.

Rationale: to create a baseline of the patient’s nutritional status and preferences.

3. Help the patient to select appropriate dietary choices to avoid gluten-containing foods.

Rationale: even the slightest amount will trigger an immune system reaction that can damage

the patient’s small intestine.

4. Refer the patient to the dietitian.

Rationale: to provide a more specialized care for the patient in terms of nutrition and diet in

relation to newly diagnosed Celiac disease.

5. Administer supplements of vitamins and minerals as prescribed.

Rationale: vitamin and mineral supplementation may be required for nutritional deficiencies.

6. Provide nutritional education for patient and parent

Rationale: we must educate them about the foods that contain gluten as well as which foods

are gluten free. Also, help them understand how to read food labels and educate regarding

possible trigger foods.

7. Create a daily weight chart and food chart

 Rationale: to effectively monitor the patient’s daily nutritional intake and progress in weight

goals.

PROGNOSIS

Most people who adhere to a strict gluten-free diet have an excellent prognosis, as the

damage done by celiac disease can be undone, leading to improved absorption of nutrients and

resolution of symptoms.

Celiac disease is an autoimmune disorder that harms the small intestine when gluten-

containing foods are eaten. However, following a strict gluten-free diet can lead to a good long-

term outlook. People who have been diagnosed and stop eating gluten have a positive prognosis

because most of the damage caused by celiac disease can be reversed. Not adhering to the gluten-

free diet can result in serious complications like malnutrition, osteoporosis, infertility, neurological

disorders, and an increased risk of certain cancers. It's vital for individuals with celiac disease to

work with a healthcare provider and a registered dietitian for strict adherence to a gluten-free diet

and proper management of associated conditions, leading to a healthy and active lifestyle.

RECOMMENDATIONS

1. Educate patients on the importance of following a gluten-free diet, including how to read food

labels, identifying hidden sources of gluten, and recommending gluten-free alternatives.

2. Encourage patients to work with a registered dietitian to create a balanced gluten-free meal

plan that meets their nutritional needs.

3. Address any psychosocial concerns related to the diagnosis, such as anxiety, depression, or

4. social isolation, and provide appropriate support and resources.

5. Encourage patients to join a celiac support group to connect with others who have the same

condition and share experiences, tips, and advice.

6. Help patients identify and address any barriers that may prevent them from following a gluten-

free diet, such as cost, access, or social situations, and provide resources and solutions.

7. Monitor patients for any signs of nutritional deficiencies, such as iron, calcium, or vitamin D,

and refer them to a healthcare provider or registered dietitian for further assessment and

treatment.

8. Work with patients to develop coping strategies to manage the emotional and psychological

impact of living with a chronic illness, such as stress reduction techniques, relaxation exercises,

or mindfulness practices.

9. Provide patients with information and resources on how to navigate social situations and dining

out while maintaining a gluten-free diet, such as contacting restaurants ahead of time, bringing

their own food, or using gluten-free apps and guides.

10. Manage symptoms and prevent complications by following a strict gluten-free diet that avoids

all foods containing gluten.

11. Address any nutrient deficiencies that may be present due to malabsorption by taking vitamin

and mineral supplements and working with a registered dietitian to plan meals and ensure

nutritional needs are met.

12. Undergo regular check-ups to monitor the effectiveness of the gluten-free diet in managing

symptoms and preventing complications such as osteoporosis, infertility, and certain types of

cancer.

13. Provide counseling and support to help patients cope with the challenges of living with a

chronic condition.
 REFERENCES

Catassi, C., Gatti, S., & Lionetti, E. (2015). World perspective and celiac disease epidemiology.

Digestive diseases, 33(2), 141-146.

Celiac Disease. (2017). WebMD. Retrieved April 24, 2023 from:

https://www.webmd.com/digestive-disorders/celiac-disease/celiac-disease

Celiac disease - Diagnosis and treatment - Mayo Clinic. (2021). Retrieved April 24, 2023 from:

Mayoclinic.org; https://www.mayoclinic.org/diseases-conditions/celiac-disease/diagnosis-

treatment/drc-20352225

Celiac Disease - Nursing care and management plan, procedure and aftercare. (2019).

Retrieved April 24, 2023 from: Studocu;

https://www.studocu.com/ph/document/university-of-east-anglia/childrens-nursing/celiac-

disease-nursing-care-and-management-plan-procedure-and-aftercare/17197473

Celiac Disease: Symptoms & How It’s Treated. (2022). Cleveland Clinic. Retrieved April 24,

2023 from: https://my.clevelandclinic.org/health/diseases/14240-celiac-

disease#:~:text=Most%20people%20who've%20been,may%20have%20a%20secondary%

20condition

Elsouri, K., Arboleda, V., Heiser, S., Kesselman, M. M., & Beckler, M. D. (2021). Microbiome

in Rheumatoid Arthritis and Celiac Disease: A Friend or Foe. Cureus.

https://doi.org/10.7759/cureus.15543

Fluid Volume Deficit (Dehydration) Nursing Diagnosis & Care Plan. (2021). NurseTogether.

Retrieved April 24, 2023 from: https://www.nursetogether.com/fluid-volume-deficit-

nursing-diagnosis-care-plan/
Goebel, S. U., MD. (n.d.). Celiac Disease (Sprue) Clinical Presentation: History, Physical

Examination. https://emedicine.medscape.com/article/171805-clinical#b1

Jaimehannans. (2014). Celiac Disease Case Study: Liz Galvin. Pressbooks.pub;

Pressbooks.https://pressbooks.pub/sncasestudies/chapter/celiac-disease-case-study-liz-

galvin/?fbclid=IwAR2T7vSqbV4w20KGIF9usL7Guj4o3WpEUnye4RhtDqg73nER1LkrJa

qeboM

Monar, G. V. F., Islam, H., Puttagunta, S. M., Islam, R., Kundu, S., Jha, S. B., Rivera, A. L., &

Sange, I. (2022). Association Between Type 1 Diabetes Mellitus and Celiac Disease:

Autoimmune Disorders With a Shared Genetic Background. Cureus.

https://doi.org/10.7759/cureus.22912

National Institute of Diabetes and Digestive and Kidney Diseases (2023). Celiac Disease -

NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved April

24, 2023 from: https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-

disease

News-Medical. (2013). Celiac Disease Pathogenesis. News-Medical.net. Retrieved April 24,

2023 from: https://www.news-medical.net/health/Celiac-Disease-Pathogenesis.aspx

Rd, R. a. M. (2023). 9 Symptoms of Celiac Disease. Healthline. Retrieved April 24, 2023 from:

https://www.healthline.com/nutrition/celiac-disease-symptoms#TOC_TITLE_HDR_6

UpToDate. (2023). Uptodate.com. Retrieved April 24, 2023 from:

https://www.uptodate.com/contents/epidemiology-pathogenesis-and-clinical-

manifestations-of-celiac-disease-in-adults
What is Celiac Disease? | Celiac Disease Foundation. (2022). Celiac Disease Foundation;

Celiac. Retrieved April 24, 2023 from: https://celiac.org/about-celiac-disease/what-is-

celiac-disease/

Wayne, G. (2016). Fluid Volume Deficit (Dehydration) Nursing Care Plans. Nurseslabs.

Retrieved April 24, 2023 from: https://nurseslabs.com/deficient-fluid-volume/